A Breast MRI at Wake Radiology Uncovered the Truth
Anita Jacobs (patient’s name has been changed to protect her identity) had her first run in with breast cancer at age 46. 4 years after her breast cancer was treated, she went in for her annual diagnostic mammogram and was called back for additional images. After talking with the radiologist and her surgeon, they suggested she have a Breast MRI at Wake Radiology for an in depth look at what was showing up on her mammogram. “I was really happy about this option because it was not invasive—no needles or scarring” said Jacobs. “I was also reassured by the doctors at Wake Radiology that they would find out what was going on with me.” After successful conservative treatment for breast cancer, scarring is a natural response in the treated breast. This can sometimes present a problem for patients over time because on a mammogram scarring can look exactly like a tumor, growing again in the treatment site. Ultrasound commonly cannot help determine if the new abnormality in the treated breast is a new cancer—or just scarring.
Positive Impact of Breast MRI
Before 2005, patients in this predicament would have had a surgical biopsy at the treatment site to prove that cancer had not recurred. Not only was this expensive (more than $15,000) it had risks associated with it that might otherwise be avoided if there were other imaging methods (besides mammogram and ultrasound) that could help. In addition, the surgical biopsy commonly started an “endless loop” of more scarring, more worries in follow-up and, unfortunately in some cases, even more surgical biopsies. It was not until Breast MRI was developed that a non-surgical imaging method could reliably determine if cancer recurred, or if the abnormality was merely post treatment scarring. Now, women who have survived breast cancer with conservative therapy do not need to undergo biopsy after biopsy if their mammograms appear “suspicious for tumor recurrence.” If you are a breast cancer survivor, you are at increased risk of cancer in the treated breast, as well as the opposite breast. Talk to your doctor to find out if a Breast MRI may be a helpful addition to your surveillance breast imaging after therapy. The patient’s mammogram after lumpectomy demonstrated a stellate area of tissue in the operative site. A magnification view of the mammographic abnormality made it look even more like a tumor was regrowing in the operative site. In the past, the only way to determine if this was true was another surgery to remove this area. Instead, the patient’s physician realized that this is an ideal scenario in which to use MRI to decide if there was recurrent tumor, or just scar. This image of the MRI, obtained before the administration of intravenous contrast, again made the area in the operative site look like a tumor had recurred. However, after contrast was administered intravenously, the area demonstrated no enhancement. If tumor had recurred, it would be expected to enhance, or “light up” with contrast. Instead it did not, which is indicative of scar. This final picture from the MRI depicts “ghost like” outlines of each breast, as if you were looking up from the patient’s feet. The left breast and right breast demonstrate the same pattern on this post contrast image. No enhancement is seen in the breast of concern. It looks just like the other normal breast. Thus, there is no cancer despite the abnormal appearance of the mammogram. MRI has an accuracy in literature approaching 100% for the determination of recurrent cancer vs. scar in this clinical setting. Because it is “as good as a biopsy”, it has essentially ended the need for reoperation in these cases. Dr. Glenn Coates Director of Body Imaging Wake Radiology